UK researchers examining economic data on 12 non-pharmacological interventions for osteoarthritis of the knee (KOA) have found acupuncture and transcutaneous electrical nerve stimulation (TENS) to be cost-effective. The authors applied network meta-analysis to data from 88 randomised controlled trials including 7,507 patients. They based their cost-effectiveness estimations on a threshold of £20–30,000 per QALY (quality-adjusted life year – a measure of disease burden used to assess the value for money of medical interventions), as this is used by the UK’s National Institute for Health and Care Excellence (NICE) to assess whether treatments represent a cost-effective use of UK NHS resources. When all trials were considered, TENS was found to be cost-effective at the NICE threshold, with an incremental cost-effectiveness ratio of £2,690 per QALY versus usual care (meaning one quality-adjusted life year would be gained for each additional £2,690 spent on TENS). When only higher quality trials were considered, acupuncture was found to be cost-effective (with an incremental cost-effectiveness ratio of £13,502 per QALY versus TENS). The authors further noted that, while acupuncture is not currently recommended by NICE as a treatment for KOA, based on their calculations some interventions that are recommended by NICE (insoles, braces and manual therapy) are unlikely to be cost-effective and therefore should not be prioritised for commissioning within the NHS.
Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLoS One. 2017 Mar 7;12(3):e0172749.

A study by investigators from the UK suggests that both group and individual acupuncture may be effective for treating the symptoms of knee osteoarthritis. In a pilot randomised trial, 120 patients received either a standardised advice/exercise booklet, the booklet plus group acupuncture, or the booklet plus individual acupuncture. Both acupuncture groups received up to ten treatments over 12 weeks using four local standard points (Yinglingquan SP-9, Xuehai SP-10, Yinshi ST-33, Zusanli ST-36) plus up to four ahshi points, with manual stimulation applied unless no pain relief was reported, in which case electro-acupuncture was used. Mean reductions in osteoarthritis symptom scores from baseline to 14 week follow-up were greatest for group acupuncture (-3.2), followed by individual acupuncture (-2.4), both of which were significantly better than the booklet group (who experienced a mean increase in symptom scores of 0.4).
Western medical acupuncture in a group setting for knee osteoarthritis: results of a pilot randomised controlled trial. Pilot Feasibility Stud. 2016 Feb 16;2:10.

A research team from the American National Institutes of Health has concluded that tai chi produces beneficial effects similar to those of a standard course of physical therapy for knee osteoarthritis. The team randomly assigned 204 participants with symptomatic knee osteoarthritis to tai chi training (two one-hour sessions each week for 12 weeks) or standard one-on-one physical therapy (two 30-minute sessions per week for six weeks, followed by six weeks of home-based exercises). Both groups were then encouraged to continue their tai chi practice or home exercise for a total of 52 weeks. Patients in both groups reported a decrease in pain levels at 12 weeks. The amount of change in pain between baseline and 12 weeks did not differ between the groups. Patients in both groups showed a similar improvement in physical functioning. Those in the tai chi group showed more improvement in their depression symptoms and quality of life than those in the physical therapy group.

Six-weeks of treatment with moxibustion seems to improve physical and mental quality of life in patients with chronic knee osteoarthritis (KOA). Chinese investigators randomly allocated 150 patients with KOA to either a true moxibustion group (n=77) or a sham moxibustion group (n=73), who received treatment three times a week for six weeks. Participants in the true moxibustion group experienced significantly greater improvement in general health scores than the sham group at weeks 6 and 12. Participants in the true moxibustion group also experienced statistically significantly greater improvement in vitality scores than the sham group at week 12. (Effectiveness of moxibustion treatment in quality of life in patients with knee osteoarthritis: a randomized, double-blinded, placebo-controlled trial. Evid Based Complement Alternat Med. 21)15;2015:569523. Epub 2015 Jan 21).

A 12-week balance training program combining tai chi and strength training (TCST) can effectively improve balance and aerobic capacity in patients with end-stage osteoarthritis who are awaiting hip surgery. A total of 81 patients aged from 60 to 69 years old were randomly divided into two groups: a training group (TG) and a control group (CG). Participants in TG performed TCST at home under their family’s supervision for 12 weeks. After 12 weeks of training, the mean distance travelled in a six-minute walk was found to have increased from 409 metres to 478 metres in the TG, and the mean ‘Timed Up and Go’ test score had also significantly improved from 18.53 to 14.61. Self-reported functional status scores were also reported to have improved from 40.97 to 36.28, although there were no significant changes in pain or hip motion scores, meaning that hip surgery was still necessary. (A randomized controlled trial: Preoperative home-based combined Tai Chi and Strength Training (TCST) to improve balance and aerobic capacity in patients with total hip arthroplasty (THA). Arch Gerontol Geriatr. 2014 Dec 13. pii: S0167-4943(14)00221-0).

Acupuncture should be considered to be one of the most effective treatments for short-term alleviation of knee pain from osteoarthritis (OA), according to a network meta-analysis of randomised controlled studies by UK authors. This type of meta-analysis is gaining popularity among clinicians, as it allows comparison between multiple interventions that have been used to treat the same condition, even if there has not been a ‘head-to-head’ comparison in the original studies. Data suitable for analysis came from 114 trials which used a total of 22 different treatment modalities to treat 9,709 patients. Eight interventions, including acupuncture, were found to result in statistically significant reductions in pain, compared with standard care. Most trials studied only short-term effects of treatment and many were classed as being of poor quality. The trials that were judged to be of high quality were mostly studies involving acupuncture (11 trials) or muscle-strengthening exercise (9 trials). Both of these interventions were found to be significantly better than standard care, with acupuncture performing better than muscle-strengthening exercise. Acupuncture was shown to be significantly superior to sham, and in addition it was shown to outperform most of the physical therapies recommended by the UK’s National Institute for Health and Care Excellence (NICE) in its 2008 guidelines on treatment of knee OA. The authors report that the effect sizes for acupuncture compare favourably with those of pharmacological treatments, and recommend that acupuncture should be considered to be an evidence-based treatment option with a credible role to play in the management of knee OA pain. (Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage. 2013 Sep;21(9):1290-8).
Meanwhile, a small US-based longitudinal study of 30 knee OA patients has found that, compared with sham acupuncture, real acupuncture produces better clinical outcomes for both pain and function. Sensations of soreness and aching during needling were implicated as the two key sensations that differentiate real acupuncture from superficial acupuncture. (A longitudinal study of the reliability of acupuncture deqi sensations in knee osteoarthritis. Evid Based Complement Alternat Med. 2013;2013:204259).